Coital incontinence: a factor for deteriorated health-related quality of life and sexual function in women with urodynamic stress urinary incontinence: Beyond the Abstract

Pelvic floor disorders are a common occurrence and, with the aging population, the number of women complaining of urinary incontinence and pelvic organ prolapse steadily increases. The article focuses on the underestimated problem of coital urinary incontinence (CI).

Urinary incontinence affects all areas of life and results in significantly deteriorated quality of patient life. The symptoms negatively influence the ability to engage in physical activity, to travel, to take part in social activities, and even to perform domestic chores. Also, it may cause the feelings of nervousness and frustration. Sexual function and sexual health is an important domain of life. In order to prevent and hide leakage, women with UI change not only their everyday life but also their sexual function. They modify their sexual behavior to prevent, limit, or even hide urinary leakage. Sometimes they reduce the frequency of sexual activity or even abstain from sexual intercourse altogether. Healthcare professionals rarely discuss the problem of coital incontinence with their patients, while the affected women frequently do not reveal the symptoms without direct questions.

The two condition-specific questionnaires used in this study were: King’s Health Questionnaire (KHQ) to assess general quality of life, and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ) to analyze sexual function. Both questionnaires are widely applied and constitute valuable tools in urogynecological patients.

The methodology of this study required us to select two groups out of women with stress urinary incontinence (SUI). Women with SUI reporting coital incontinence ‘sometimes’, ‘usually’ or ‘always’ constituted the study group, while the comparative group included patients with stress urinary incontinence but without coital incontinence.

In our study, we proved that coital incontinence not only lowers the quality of sexual function, but also negatively influences the quality of life.

KHQ revealed that women with CI as compared to controls had significantly lower quality of life in the following questionnaire domains: general health, incontinence impact, role limitations, physical limitations, social limitations, personal relationships, emotions and severity measures, with the exception of sleep/energy. Although even in the latter domain the differences approached borderline statistical significance.

As for the quality of sexual life, women in the study group were found to have deteriorated sexual function in the physical domain of the PISQ as compared to controls, but the overall sexual function did not differ between both groups. Additionally, a detailed table was placed in the paper, to present PISQ Physical domain questions and given responses in the study and control groups (Table 4).

I hope that the study will prompt my fellow researchers for further analysis of sexual function in female urogynecological patients. Urinary incontinence remains a sensitive topic and is presumed to be associated with aging and infirmity. Pelvic floor disorders are probably among the last diseases to cause embarrassment. Still, they often are the reason why patients withdraw from social or family life and, as presented in our paper, sexual life as well. Fortunately, owing to various awareness campaigns, knowledge about urinary symptoms raises among the general population.

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Written by: Magdalena Emilia Grzybowska, MD PhD